Massachusetts RN Appeals Administrator

A company is looking for an RN Denials and Appeals Administrator, Per Diem. Key Responsibilities Manage the pre-denial, denial, and appeal processes, ensuring compliance with Utilization Review standards Utilize medical necessity screening tools for initial and continued stay reviews to determine appropriate patient care levels Collaborate with payers to secure authorization for clinical services in a timely manner Required Qualifications, Training, and Education Nursing degree: Diploma, ASN, or BSN (preferred), with the ability to obtain a BSN within 4 years MA RN License required; CCM or ACM certification preferred 3-5 years of related experience in healthcare case management and patient insurance/billing Preferred 3-4 years of supervisory experience Comprehensive knowledge of clinical documentation, medical coding, and patient financial billing regulations

Feb 11, 2025 - 12:58

A company is looking for an RN Denials and Appeals Administrator, Per Diem. Key Responsibilities Manage the pre-denial, denial, and appeal processes, ensuring compliance with Utilization Review standards Utilize medical necessity screening tools for initial and continued stay reviews to determine appropriate patient care levels Collaborate with payers to secure authorization for clinical services in a timely manner Required Qualifications, Training, and Education Nursing degree: Diploma, ASN, or BSN (preferred), with the ability to obtain a BSN within 4 years MA RN License required; CCM or ACM certification preferred 3-5 years of related experience in healthcare case management and patient insurance/billing Preferred 3-4 years of supervisory experience Comprehensive knowledge of clinical documentation, medical coding, and patient financial billing regulations